- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.39 / $290.79 / $520.28
| Professional | | $272.39 | $290.79 | $520.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.67 / $349.67 / $454.97
| Professional | | $349.67 | $349.67 | $454.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.63 / $380.63 / $380.63
| Facility | | $380.63 | $380.63 | $380.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.86 / $277.86 / $380.63
| Professional | | $277.86 | $277.86 | $380.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.89 / $665.55 / $958.39
| Professional | | $465.89 | $665.55 | $958.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.56 / $332.03 / $529.25
| Professional | | $257.56 | $332.03 | $529.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.95 / $364.95 / $465.89
| Professional | | $364.95 | $364.95 | $465.89 |